Last month I wrote about health care reform and how two of the three parts of President Obama’s goals were easy to accomplish ( choice of health care plans and medical providers and access by all Americans to affordable health insurance coverage) but the third is near impossible under current conditions (rein in costs). In my May 15th blog, I talked about the Yin and Yang of Health Care, whereby the health care system, which is somewhat dysfunctional, is merely a by-product of the health care industry, which is focused on growth and profitability. Those very powerful industry forces along with the fear of a government take over and added federal costs, will, I believe, preclude any major health reform this year. I hope I am wrong, but I am skeptical that we will see much in the way of major reform. That’s not to say that there won’t be some incremental change, such as added regulation of insurance companies that require them to create an affordable individual, as opposed to group, insurance product. I suspect that these plans will resemble a catastrophic insurance model that will come with high deductibles and co-insurance payment. This will further move the U.S. away from an employer based insurance system (currently only 65% of all employers provide health insurance) to an individual market. This may not be all that bad depending on how helpful the health plans are in dealing with individual customers, rather than groups.
All of the possible changes that may occur will move us toward what I call YOYO Health Care: Your-On-Your-Own. We must all get used to making choices on our own regarding health insurance plans, medical providers, and treatment options. Already there is a move by major health systems and insurers to create a "Shared or Informed Decision Making" environment. In Boston, Partners Health Care is promoting the idea of sending patients with certain conditions educational DVDs. Conditions include, Coronary Artery Disease, HIP Osteoarthritis, Spinal Stenosis, Prostate Cancer, Herniated Discs, etc.
YOYO Health Care may work on the cost part of President Obama’s trilogy if there are real incentive built into health reform for self care, prevention, and wellness. In reality, the only thing that is going to slow health care spending is for consumers to avoid acute illness and to better manage chronic illness. Under the current system where the health care industry is rewarded for doing more, more care will be provided. In fact, the health care industry would like nothing more than to "sell" more of its products and services. This helps achieve their revenue growth and profitability goals.
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Although I'm also concerned about the lack of current focus on controlling costs, as a person with multiple medical conditions and modest income, I fear being priced out of healthcare altogether by the plans you envision.
ReplyDeleteIn my experience, although providers often pay lip service to medical consumerism, in practice they have little tolerance for patients who want to be informed and share in decision-making: It takes more of their time, and they have to share control with people who have little medical knowledge.
My insurer sends me literature, has nurses call me, etc. However it is all very elementary and seldom provides with the sort of information I need deal with my medical problems. These days, patients who are interested in learning more read that material and much more on the internet.
A better way of saving money may be to focus on shifting away from having very highly trained people (doctors) involved in every medical experience and instead relying on technicians, nurses, computer programs, and certified health practitioners (e.g. as envisoned by Stephen Hyde in is article The Last Priesthood) for all but the most complex diagnostics and treatment.